EMS and Medical Transport Routes:
Complete Guide

You typically need $100,000 to $150,000 to start a small EMS or ambulance business with two vehicles.

Startup costs include the ambulance, medical equipment, licensing, insurance, and initial payroll. Most new operators reduce upfront costs by buying a used ambulance and financing it, rather than purchasing new.

You’ll also need working capital to cover 60–90 days of expenses before insurance reimbursements begin.

Costs can be higher depending on your location, staffing needs, and whether you’re launching a single ambulance or a fleet.

You should plan to be very hands-on for the first 6 to 12 months when starting an EMS or ambulance business.

Most new owners treat the first year as a full-time commitment, managing operations, compliance, staffing, and cash flow, as well as marketing to acquire new clients while the business stabilizes.

After systems and management are in place, many owners can reduce involvement to 10–20 hours per week in a CEO-style role, but you should never be completely hands-off due to regulatory and safety requirements.

You need at least two ambulances to start an EMS or ambulance business.

One ambulance runs calls, and the second serves as a backup for maintenance, cleaning, or unexpected breakdowns. A single-ambulance operation is risky and often not viable because any downtime can stop revenue and jeopardize contracts.

As you grow, you can scale your fleet, but two units is the minimum recommended starting point.

No, you do not need a medical degree or any clinical license to start and run an EMS business.

Medicine is required on the truck. but it’s optional in the owner’s chair. However, holding your own paramedic license gives you three big advantages:

1. Instant credibility with crews and clients

2. The ability to serve as backup during staffing conflicts

3. Deeper insight into protocol changes, drug shortages, and scope-of-practice battles that directly impact your bottom line.

Your main responsibilities as owner are hiring and retaining licensed EMTs/paramedics, securing vehicles and insurance, hiring and reviewing billing companies, and ensuring compliance with state and local protocols.

Additionally, the state issues the service license to the company, not to an individual practitioner. You will have a qualified Medical Director to oversee protocols, quality assurance, and credentialing of your clinicians.

Most BLS EMS companies get patients through facility contracts and referrals, with only a few coming in through direct patient calls.

Non-emergency transports usually come from dialysis centers, nursing homes, hospitals, hospice providers, and assisted living facilities. Your primary “marketing” is building relationships with discharge planners, social workers, nurses, and facility administrators who control referrals.

To grow volume, EMS owners focus on securing preferred provider agreements and becoming the most reliable transport option in their service area.

You must apply for an EMS or ambulance service license through your state’s EMS office or health department. There is no national EMS license, so requirements, fees, and timelines vary by state.

Some states approve licenses in 30–90 days, while others can take 6–12 months or longer. Costs can range from $50 to $10,000+ depending on the state.

Most states require a registered business entity, vehicle inspections, insurance, and a medical director agreement before approval.

You can buy an ambulance from used ambulance dealers, specialty dealerships, other EMS companies, or online marketplaces like Facebook Marketplace.

Most new EMS owners start with a used ambulance in the $40,000–$90,000 range to reduce upfront costs. Networking with other EMS operators can also uncover private sales when companies upgrade their fleets.

Always inspect the vehicle, check maintenance records and title status, and budget for initial setup costs like radios, decals, and servicing.

Most small EMS and ambulance business owners can expect $60,000 to $150,000 per year in take-home profit once the business is stable.

In the first year, many owners earn $40,000 to $80,000 with one to two ambulances. As you scale contracts, increase call volume, and improve efficiency, profits can grow to $120,000+ per year.

Profit potential varies by location. Urban markets often generate higher volume and reimbursement rates, while rural markets may have lower volume but less competition and lower operating costs.

Typical net profit margins in non-emergency EMS transport are 10% to 20%, with revenue driven by transport volume and reimbursement rates.

Yes, most states require a dedicated base station or office space to license an EMS or ambulance business.

This space is used for administration, crew staging, medical record access, and secure storage of supplies and medications. Many states also require vehicle parking, inspections, and a physical address that can be inspected by regulators.

Virtual offices and residential garages are typically not allowed for EMS licensing.

Yes, you can finance an EMS or ambulance business through banks, SBA loans, equipment lenders, and specialty healthcare lenders.

Most lenders require 10%–25% down, a business plan, and financial projections. SBA 7(a) loans are commonly used to finance ambulances, facility build-out, and working capital.

Having a medical director agreement, referral letters from facilities, and insurance quotes can significantly improve approval odds.